Mark Wainberg: Taking Aim on AIDS

ENTRE NOUS

withMark Wainberg, Director,

McGill AIDS Centre

Taking aim on AIDS

‘I think governments, no matter what their political stripe, should be guided by science to set policy,’ says Mark Wainberg, Director of the McGill AIDS Centre.

By Neale McDevitt

Fresh off the red-eye from L.A. where he was visiting his grandchildren, Mark Wainberg poked fun at our photographer when it was suggested that he change his shirt for the photo shoot. "The New York Times never asked me to change my shirt," laughed the Director of the McGill AIDS Centre, over his shoulder as he hustled to his car to get a change of wardrobe. A leading HIV/AIDS researcher and activist, Wainberg is tireless; meeting with scientists, world leaders, industrialists and Hollywood celebrities in his ongoing quest to raise awareness and shape policies geared toward slowing the spread and, ultimately, eradicating the dreaded disease. Having donned a fresh shirt, Wainberg sat down with the Reporter to talk about where the world stands on the eve of World AIDS Day.

Why are HIV infection rates on the rise in Canada?

I think in part because the drugs work so well. Whatever fear people used to have in contracting HIV has dissipated to a certain extent. Nowadays, a lot of vulnerable people say, ‘It’s not such a big deal if I get HIV infected because the drugs will keep me alive for a very long time.’ We are largely victims of our own success.

So now we have a new generation of young people who see HIV/AIDS more as a chronic illness than the outright killer it was early on?

Right. There are a lot of vulnerable people out there, including gay men, who have never seen a loved one die of AIDS.

What will it take to stop this rise?

I hate to say this, but maybe we need to do a better job in scaring people. There are some fairly new findings starting to come out that show how long-time HIV-infected people—even though their HIV is well treated—seem to be developing cancers at a very high rate. Maybe this will help bring that element of fear back. You don’t want to be alarmist, you want to be responsible in addressing these issues from a public health standpoint, but also, you want to be fair to people.

Promiscuity is still an issue, no?

I don’t think it’s a horrible thing to say, but among some of the vulnerable populations, there seems to be higher rates of promiscuity than may apply in the population at large. Maybe people who take as a right to be as promiscuous as they want to be should rethink some of these issues. But these are topics that are best handled by leaders in community groups. I don’t think people in high risk situations want to hear about this stuff from me. They want to hear it from peers.

How do we stand in the fight against HIV/AIDS compared to 10 years ago?

There is no question that we’re better off. Here in Canada the drugs work well and everyone who needs those drugs gets them. But in developing countries, people are dying all the time because they don’t have access to the same drugs. In many ways, HIV/AIDS is like two different diseases.

What’s the answer for developing countries?

I think countries like Canada, in other words the world’s rich countries, have a moral responsibility to step up and do more to buy drugs and make contributions to international agencies so that people who live in developing countries can have access to life-saving drugs without which they will die.

Then it is strictly a question of cost?

Absolutely. But we’ve already made a lot of progress in that area. The drugs that are available now in developing countries are no longer the brand-name versions. Having these low-cost versions available is a huge step in the right direction. It took the drug companies a long time to swallow that pill, but they did it.

With all we know about HIV/AIDS, how is it possible that there are still HIV-deniers, most notably South African president Thabo Mbeke?

This is a very serious issue. President Mbeke is a political leader with enormous clout. As leader of the country he espouses beliefs that fly in the face of science. In doing so, he is sending a dangerous message to his people. I know the issues aren’t simple. After all, we are talking about a democratically elected government.

That being said, President Mbeke seems to have gone out of his way in recent months to reaffirm his denialism and has been trying to include staunch anti-denialists members of his government along with him. It has been very frustrating for people fighting HIV/AIDS and trying to make the world a better place.

Staying with Africa, you’ve had great success with countries like Kenya in turning their policies around. How difficult is to change people’s minds?

Kenya, Ethiopia—I think a lot of African nations have really turned the corner in regards to establishing policies that make sense to them. Africa is very conservative compared to North America, especially when it comes to talking about sex openly. It takes time to persuade political leaders not to put their head in the sand.

Responsible political leaders have to understand that people are not going to abstain just because you ask them to and responsible political leaders have to be willing to discuss condom usage. Now, in the aftermath of research that shows benefits of male circumcision in terms of HIV prevention, they have to be willing to talk about circumcision as well.

In terms of the educational process, how valuable is it to have celebrity activists like Richard Gere on board?

Last year a lot of people at the International AIDS Conference criticized us for inviting people like Richard Gere, Bill Gates and Bill Clinton because they feel that all this star power is detracting from the scientific message. My attitude was "Really? How so?" The reality is, people get star-struck—I know I do. But if these celebrities help bring the world’s attention to the problem of HIV/AIDS and articulate for condom usage in Africa, why is that bad?

It’s part of getting out the educational message. We rely on the journalists to deliver that message but the fact of the matter is, the journalists might not even show up if they don’t have people like Richard Gere and Bill Clinton to focus on.

Here we have the student-based McGill Global AIDS Coalition. What is the students’ role in all this?

I think it is wonderful that the McGill student body has become galvanized to want to do something about AIDS worldwide. We have a number of students volunteering in African countries because they want to make a difference. It speaks well of McGill and of our students.

How long have you been involved in AIDS research?

Since the beginning of the epidemic. I was probably one of the very first scientists in Canada to get involved full time. My own involvement dates back to 1983-84.

Tell me about your current research.

From the outset, our research was focused on HIV drugs. We helped develop the drug 3TC which has been a great success. But we’re also one of the big labs in the field of understanding HIV drug resistance. We need to know how the virus mutates so quickly to become resistant to the drugs we use in therapy.

There are a lot of prevention strategies now being contemplated in developing country settings where the prevention modality actually involves HIV drugs. In other words, instead of using the drugs to treat people, why can’t we use the same drugs to prevent infection?

You mean like a vaccine?

Not a vaccine. A vaginal microbicide or vaginal foams or jellies, for example, that will protect a woman about to engage in sexual relations against HIV transmission. Female sex workers could benefit from such a thing. We’re doing projects that relate to this.

How close are we to developing a vaccine?

Unfortunately we’re not very close at all. Just about a month ago, Merck announced the failure of what we all thought was a very promising vaccine concept. The consensus in the field now is that, absolutely vaccine research has to go ahead, but it’s not going to be easy and it’s not going to be soon. It will be at least 10 years before we have anything that will even resemble a successful vaccine.

What about harm-reduction measures?

Most of us knee-jerk liberals would argue, based on science, that providing drug addicts with clean needles and syringes will lower their chance of getting HIV. Of course, it is a tricky issue. Just look at the US, where the current administration has had its head in the sand for years and is not one to be handing out clean needles any time soon.

Unfortunately, statistics just coming out of the US are showing new infection rates even higher than ours here in Canada. It just proves that you can’t set public policy on HIV—or any other sexually transmitted illness, for that matter—on the basis of wishful thinking.